and Human Services
policy and funding
guidelines 2016
Volume 2: Health operations 2016–17
Chapter 3: Pricing arrangements for
Victoria’s health system
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Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.
© State of Victoria, Department of Health and Human Services July 2016.
Where the term ‘Aboriginal’ is used it refers to both Aboriginal and Torres Strait Islander people. Indigenous is retained when it is part of the title of a report, program or quotation.
Available at <https://www2.health.vic.gov.au/about/policy-and-funding-guidelines>.
Printed by Impact Digital, Brunswick (1605009)
Contents
Chapter 3: Pricing arrangements forVictoria’s health system 143
Introduction to Chapter 3 144
3.1 Price tables 145
3.1.1 Acute and subacute 145
3.1.2 Mental health and drug services 147
3.1.3 Ambulance 150
3.1.4 Ageing, aged and home care 151
3.1.5 Small rural health services – ageing, aged and home care 153
3.1.6 Primary, community and dental health output group 154
3.1.7 Training and development 155
3.2 Peer groups for WIES purposes 156
3.3 Cost weight tables 158
3.3.1 WIES23 Victorian cost weights 158
3.3.2 Subacute WIES1 cost weights 224
3.4 Subacute service capability framework levels and health services alignment 2016–17 229
3.5 Maternity capability framework levels and health services alignment 2016–17 233
3.6 Output and activity tables 235
Appendix 3.1: Calculating WIES23 for individual patients 250
A3.1.1 WIES23 eligibility 250
A3.1.2 Victorian AR-DRG modifications 251
A3.1.3 Co-payments 252
A3.1.4 Base WIES23 255
A3.1.5 Aboriginal and Torres Strait Islander loading 258
A3.1.6 Calculating WIES cost weight 258
Appendix 3.2: Definition of WIES23 variables 259
Appendix 3.3: AN-SNAP technical specifications 262
A3.3.1 AN-SNAP version 4 classes 262
A3.3.2 Other key changes in AN-SNAP version 4 262
A3.3.3 Grouping to AN-SNAP version 4 264
Appendix 3.4: Calculating Subacute WIES for individual patients 271
A3.4.1 Subacute WIES eligibility 271
A3.4.2 Base Subacute WIES 272
A3.4.3 Aboriginal and Torres Strait Islander loading 275
A3.4.4 Calculating Subacute WIES cost weight 275
Appendix 3.5: Definition of Subacute WIES variables 276
Appendix 3.6: Calculating funding recall 277
A3.6.1 Calculating WIES23 funding recall 277
A3.6.2 Calculating TAC/DVA WIES funding recall 278
A3.6.3 Calculating Subacute WIES1 funding recall 278
A3.6.4 Calculating DVA Subacute WIES funding recall 279
A3.6.5 Calculating home dialysis funding recall 279
A3.6.6 Calculating bowel screening funding recall 280
List of tables
Acronyms and abbreviations
iii
Pricing arrangements for Victoria’s health system
Chapter 3: Pricing arrangements forVictoria’s health system
Introduction to Chapter 3
Chapter 3 of Volume 2: Health operations 2016–17 details the pricing arrangements for funding the broad range of services delivered in the Victorian health system. It details the prices organisations face and the rules about how these prices apply. The funding models vary across the activities depending on the nature of the service to be delivered.
These guidelines are a functional document that articulates the performance and financial framework within which state government-funded health sector entities operate. They are a reference for funded organisations regarding the parameters that they are expected to work to and within, as well as the funding linked to various services, in order to achieve the expected outcomes of the Victorian Government.
The guidelines are divided into five chapters:
• Chapter 1 sets out the key changes and initiatives in 2016–17
• Chapter 2 focuses on the financial framework for providing funding
• Chapter 3 outlines all the prices and associated cost weights that support the overall financial framework
• Chapter 4 outlines the conditions and expectations of that funding
• Chapter 5 includes the modelled budgets for organisations that receive more than $1million in health funding.
Items may be updated throughout the year. Funded organisations should always refer to the policy and funding guidelines website for the most recent version of documents and guidelines.
Where these guidelines refer to a statute, regulation or contract, the reference and information provided in these guidelines is descriptive only. In the case of any inconsistencies or ambiguities between these guidelines and any legislation, regulations and contractual obligations with the State of Victoria acting through the Department of Health and Human Services (‘the department’) or the Secretary to the department, the legislative, regulatory and contractual obligations will take precedence.
A note on terminology
The term ‘funded organisations’ in Volume 2 and all subsequent chapters, relates to all entities that receive departmental funding to deliver services. Aspects of these guidelines referring to funded organisations are applicable to all department-funded entities.
For the purposes of these guidelines, the term ‘health services’ relates to public health services, denominational hospitals, public hospitals and multipurpose services, as defined by the Health Services Act 1988, in regard to services provided within a hospital or a hospital-equivalent setting. Aspects of these guidelines that refer specifically to ‘health services’ are only applicable to these entities.
The term ‘community service organisations’ (CSOs) refers to registered community health centres, local government authorities and non-government organisations that are not health services.
These guidelines are also relevant to Ambulance Victoria, Health Purchasing Victoria, Ramsay Health Care and the Victorian Institute of Forensic Mental Health. The guidelines specify where aspects of the guidelines are relevant for these organisations.
3.1 Price tables
3.1.1 Acute and subacute
Table 3.1: Acute admitted services 2016–17
Payment / All health services $ / Metropolitan and regional $ / Subregional and local $ / Small rural $ /Public WIES23 / – / 4,640 / 4,857 / 4,724
Private WIES23 / – / 3,527 / 3,690 / 3,590
Transport Accident Commission WIES23 / 4,136 / – / – / –
Department of Veterans’ Affairs WIES23 / 4,927 / – / – / –
Table 3.2: Subacute services 2016–17
Payment / All health services $ / Metropolitan and regional $ / Subregional and local $ /Admitted public / 10,247 / – / –
Admitted private / 9,530 / – / –
Department of Veterans’ Affairs / 12,399 / – / –
TCP bed places (per diem rate) / 150 / – / –
TCP home places (per diem rate) / 55 / – / –
*State component only
Table 3.3: Non-admitted radiotherapy 2016–17
Payment / All health services $ / Metropolitan and regional $ / Subregional and local $ /WAU / 229 / – / –
Department of Veterans’ Affairs WAU / 283 / – / –
Table 3.4: Total parental nutrition and home enteral nutrition 2016–17
Payment / All health services $ / Metropolitan and regional $ / Subregional and local $ /Total parental nutrition (TPN) / 7,568 / – / –
Home enteral nutrition (HEN) / 206 / – / –
Table 3.5: Nationally funded centres program
Islet cell transplantation / 183,541
Hypoplastic left heart syndrome (HLHS) – Stage 1 / 249,969
Hypoplastic left heart syndrome (HLHS) – Stage 2 / 102,893
Hypoplastic left heart syndrome (HLHS) – Stage 3 / 101,081
Paediatric heart transplantation – no ventricular assist device (VAD) / 377,312
Paediatric heart transplantation – with ventricular assist device (VAD) / 874,718
Paediatric liver transplantation# / 308,128
Paediatric lung/heart-lung transplantation* / 373,269
Pancreas transplantation / 169,384
# Paediatric liver transplantation 55% The Royal Children’s Hospital and 45% Austin Health.
* Paediatric lung/heart-lung transplantation 85% Alfred Health and 15% The Royal Children’s Hospital.
3.1.2 Mental health and drug services
Table 3.6: Mental health – funded units applicable to clinical bed-based services 2016–17
Service element / Funded unit / 2016–17 unit price ($) /Admitted care
Acute Care – child/adolescent, adult, aged* / Available bed day / 646
Acute Care Specialist * / Available bed day / 646
Extended Care Adult / Available bed day / 554
Non-admitted care
Community Care Unit / Available bed day / 382
Adult PARC / Available bed day / 482
Youth PARC / Available bed day / 575
Specialist PARC / Available bed day / **
Aged Persons Nursing Home Supplement / Available bed day / 98
Aged Persons Hostel Supplement / Available bed day / 87
Clinical community care
Ambulatory / Community service hour / 390
Note:
* Supplement grant provided to support the acute care unit price.
Following adjustments from the 2015–16 funding approach for mental health admitted beds; some health services would not have received the same amount as provided in 2015–16. To provide budget stability for health services, a supplementary transition grant (block funding) has been applied in 2016–17.
** Not available at the time of publishing.
Table 3.7: Mental health community support services unit prices 2016–17
Service element / Funded unit / 2016–17 metro unit price ($) /Community Support Services
Individualised Client Support Packages / Client support unit / 87.21
Community Intake Assessment Function / Block grant / 339,060
Catchment Based Planning Function / Block grant / 54,250
Youth Residential Rehabilitation – 24-hr / Bed day / 209.76
Youth Residential Rehabilitation – non 24-hr / Bed day / 180.11
Aged Intensive Support / Client / 87.21
Mutual Support and Self Help
Standalone (high availability) / Weighted block grant / 221,491
Standalone (high availability) / Weighted block grant / varies
Individual support referral and advocacy / Client labour hour / 38.34
MSSH group support / Contact hour (group) / 101.44
Group education and training / Contact hour (group) / 345.64
Volunteer coordination / Hour / 44.41
Planned Respite
In home / Client contact hour / 34.63
Community / Client contact hour / 34.63
Residential / Client contact hour / 34.63
Supported Accommodation
24-hour on-site small facilities (0-11 beds) / Available bed day / 145.11
24-hour on-site small facilities (>11 beds) / Available bed day / 50.79
Non 24-hour on-site small facilities (0-11 beds) / Available bed day / 94.69
Non 24-hour on-site small facilities (>11 beds) / Available bed day / 70.40
Non 24 hour on-site other facilities (>11 beds) / Available bed day / 94.69
Table 3.8: Drug services – unit prices 2016–17
Drug Treatment Services Recommissioned Activities / Care and Recovery Coordination / 724.76
Counselling / 724.76
Intake and Assessment / 724.76
Non-Residential Withdrawal / 724.76
Theraputic Day Rehabilitation / 724.76
Youth Alcohol and Drug Supported Accommodation / 5,605.92 / 7,472.52
Koori Community Alcohol and Drug Worker / 1,887.00
Adult Residential Drug Withdrawal / Adult Residential Drug Withdrawal – 12 beds / 2,943.72
Youth Residential Drug Withdrawal / 9,390.12
Mobile Overdose Response / Mobile Overdose Response Service / 6,587.16
Rural Withdrawal / 1,692.18
Youth Outreach / 1,668.72
Women’s Alcohol and Drug Supported Accommodation / 5,605.92 / 7,472.52
Forensic Adult Residential Drug Withdrawal / Forensic Residential Drug Withdrawal – 12 beds / 2,943.94
Forensic Youth Residential Drug Withdrawal / 9,390.12
Specialist Pharmacotherapy Program / Specialist Pharmacotherapy Service / 3,054.90
3.1.3 Ambulance
Table 3.9: Ambulance 2016–17
Program area / Service / 2016–17 unit price ($) /Emergency road / Metro / 1,174
Emergency road / Rural / 1,732
Non-emergency road / Metro – stretcher / 317
Non-emergency road / Metro – clinic car / 104
Non-emergency road / Rural / 536
Treat non transport / 507
Air / Fixed wing – variable component / 2,082
Air / Fixed wing – fixed component / 2,816
Air / Rotary – variable component / 10,475
Air / Rotary – fixed component / 23,842
Membership Subscription Scheme / Single / 44.90
Family / 89.80
Note:
*Nominal unit charge.
The mechanism for payment of the fixed component of the air fees for major users will be maintained according to the current methodology. Fixed costs based on proportionate share and charged according to respective legislative arrangements.
**General patients will continue to pay the variable component only for rotary transport.
3.1.4 Ageing, aged and home care
Table 3.10: Ageing, aged and home care 2016–17
Program area / Service / Funded unit / 2016–17 estimated unit price ($) /Residential aged care* – rural small high care supplement / 1–10 places / Bed day / 10.31
11–20 places / Bed day / 7.73
21–30 places / Bed day / 6.45
Residential aged care* – public sector residential aged care supplement / Low Care Supplement** / Bed day / 5.91
High Care Supplement / Bed day / 63.75
Public sector residential aged care supplement*** / Bed day / 12.85
Residential aged care* – complex care supplement / Nursing Home Complex Care Supplement / Bed day / 38.67
Aged support services / Supporting accommodation for vulnerable Victorians – Cluster plans / Plans / 6,328
Supporting accommodation for vulnerable Victorians – Expenditure plans / Plans / 11,955
HACC primary health, community care and support / HACC Access and Support / Hour / 67.60
HACC Allied Health / Hour / 100.39
HACC Assessment / Hour / 92.01
HACC Delivered Meals / Meal / 3.34
HACC Domestic Assistance / Hour / 46.37
HACC Linkages Packages / Package / 15,307
HACC Nursing / Hour / 92.01
HACC Nursing – RDNS Top up / Hour / 106.84
HACC Personal Care / Hour / 46.37
HACC Personal Care – RDNS Top up / Hour / 72.27
HACC Planned Activity Group – Core / Per person / 13.80
HACC Planned Activity Group – High / Per person / 19.29
HACC Property Maintenance / Hour / 48.09
HACC Respite / Hour / 46.37
HACC Volunteer Coordination / Hour / 39.20
RDNS HACC Allied Health / Hour / 73.66
HACC primary health, community care and support – ACCO Services / HACC Access and Support / Hour / 67.93
HACC – Allied Health / Hour / 100.89
HACC – Occupational Therapy / Hour / 100.89
HACC – Podiatry / Hour / 100.89
HACC – Dietetics / Hour / 100.89
HACC – Speech therapy / Hour / 100.89
HACC – Physiotherapy / Hour / 100.89
HACC – Assessment / Hour / 92.47
HACC – Delivered Meals / Meal / 3.35
HACC – Domestic Assistance / Hour / 46.59
HACC – Nursing / Hour / 92.47
HACC – Personal Care / Hour / 46.59
HACC – Planned Activity Group – Core / Per person / 13.88
HACC – Planned Activity Group – High / Per person / 19.38
HACC – Property Maintenance / Hour / 48.32
HACC – Respite / Hour / 46.59
HACC – Volunteer Coordination / Hour / 39.39
Note:
*Annual funding is generally calculated as follows: